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Understanding the Effect of a Health Security Program in Advocating Universal Health Coverage and Improving Productivity of Semi-formal Female Workers in Bangladesh

OverviewThe James P Grant School of Public Health, BRAC University (JPGSPH) is conducting a study in collaboration with the Ayesha Abed Foundation (AAF) to assess the effects of the health security scheme among female artisans. The research will trace the effectiveness of an innovative health care financing system in advocating universal health coverage, where there is successful and consensual participation on the part of the workforce and the employer. The project will focus on:

• Assessing the effects of a health security scheme in changing the service utilisation and coverage in semi-formal female workers in Bangladesh • Measuring contribution of the health security scheme towards protecting the workers from catastrophic health-related expenditures• Exploring the effects of the health security scheme on the worker’s productivity

Data generated from this assessment will act as seminal evidence in advocating universal health coverage, as this study will explore all the three dimensions of UHC: service coverage, population coverage, and financial risk protection among the informal female workers in Bangladesh. The findings will provide a greater understanding of efficacy and feasibility of such programmes in the context of developing countries. The study commenced in June 2015 and is expected to be concluded by May 2016. There will be two cross sectional surveys designed as pre and post-test activities.

ActivitiesThe first phase comprised a baseline household assessment, conducted between September - October 2015 using a structured questionnaire to assess the pattern of service utilisation, out of pocket expenditure of artisans, and a spot checklist to measure capital investments at the sub-centre level. Data collectors were recruited and trained on data collection and the survey was carried out using electronic data collection protocols (tablets). A qualitative assessment has also been made to explore the perception of the artisan about the Health Security Scheme, and the motivators and barriers related to productivity at their place of employment. A productivity measurement phase has been underway since October 2015 and will continue until March 2016. Throughout the inception phase, the research team explored the operation of the main centres and the sub centres in Kushtia; productivity is being measured by introducing registry books in each sub-centre and conducting secondary data analysis on various administrative data maintained by AAF.